Provider Demographics
NPI:1659325371
Name:WHITE, STEVEN K (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:K
Last Name:WHITE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1275 21ST AVE N
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29577-7429
Mailing Address - Country:US
Mailing Address - Phone:843-448-9977
Mailing Address - Fax:843-626-7755
Practice Address - Street 1:1275 21ST AVE N
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577-7429
Practice Address - Country:US
Practice Address - Phone:843-448-9977
Practice Address - Fax:843-626-7755
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2012-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC108362086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC3670Medicare ID - Type Unspecified